EXECUTIVE SUMMARY

A new study revealed equally positive results for a diabetes management intervention delivered in a group setting in person and via phone.

  • Participants learned lifestyle skills involving weight loss and exercise.
  • More than 15% of participants lost at least 10% of their weight.
  • All participants improved their glycemic control.

Researchers found that both an in-person and phone group lifestyle intervention can lead to weight loss among patients with type 2 diabetes.1

“The two interventions were the same intervention, but delivery was different,” says Linda Delahanty, MS, LDN, RD, associate professor of medicine at Harvard Medical School. “One was in-person, group sessions, and the other had phone conference calls with four to 12 people in groups.”

The one-hour to 1.5-hour sessions focused on skill-building, nutrition, and various other activities. Participants learned lifestyle skills, such as how to lose weight and increase activity — both of which are important for diabetes management, Delahanty says.

“They encouraged portion-controlled foods, in the form of shakes, bars, and prepackaged entrees,” she adds.

Both Interventions Equally Effective

Both the in-person sessions and the conference call group sessions were equally effective, achieving 5% weight loss, Delahanty says. The mean percent weight loss at 12 months was 4.6% for the in-person lifestyle intervention and 4.8% for the conference call intervention.

“More than 15% of participants achieved at least a 10% weight loss,” Delahanty adds.

Attendance also was similar in both groups: The average attendance was 18 sessions out of 25 sessions in the first year.

“The people on the phone self-reported their weight, but they came into the site for outcome assessments,” Delahanty says. “They came in at six months and 12 months and were officially weighed.”

Many participants lost some weight after the intervention, but some were less successful in reaching at least a 5% weight loss, she says.

“These programs are not a fit for everyone,” she explains. “Some people might fare better with individual treatment therapy.” Before the intervention, researchers asked people what type of help they would prefer, and some indicated a preference for one-on-one counseling, Delahanty says.

The group interventions were successful in helping people improve their glycemic control: “Everyone improved their glycemic control, and there was no difference between the two lifestyle interventions on medical nutrition therapy,” she says. “Many of the participants were able to reduce diabetes medications or come off some of their medications.”

The lifestyle skills training included label-reading, problem-solving, behavioral goal-setting, managing stress-related eating, and learning how to reframe negative thinking into positive thinking and cognitive restructuring, Delahanty says.

Participants met weekly for 14 weeks, then met every other week for 10 weeks and monthly after that.

“During the sessions, participants were able to discuss and share strategies for how they applied these into their daily lives and help each other solve barriers to weight loss activities and goals,” Delahanty says. “It’s a low-tech intervention. We found we were doing it in a socioeconomically diverse community, where not everyone has computer access and skills. We gave people workbooks whether they met in-person or on the phone. There were no computer visuals for the in-person sessions, so the delivery formats were very similar.”

This also made the program scalable. When researchers started the study, they thought the in-person group program would work better than the conference calls, Delahanty notes.

“At the outset of the study, many participants believed they needed in-person group accountability to be successful with weight loss, and we also thought, potentially, the in-person group program would be better,” she says. “But we were pleased to see how well the phone intervention worked in helping them lose weight and manage diabetes.”

Calls Offer Time, Financial Benefits

The patients who attended the conference calls also were pleased with not having to travel to be part of the program. “There is the potential for broader reach and removing barriers through the telephone conference calls,” Delahanty says. “This really offers a great potential for scaling up these programs across the country.”

The financial benefit of conference calls chiefly went to patients. “The cost of the lifestyle intervention was the same for in-person and conference calls,” Delahanty says. “The idea of comparing the two treatment arms is because in recruiting people for these programs, we found a major barrier was transportation.” People did not want to drive into the city and give up the time the travel entailed.

The next step is to evaluate weight loss and sustainability of an intervention like this and to better predict who does best with in-person, phone, and other methods.

“It’s true that one size does not fit all for any lifestyle and nutritional program, so we need to have different types of programs for people with varying needs,” Delahanty says.

REFERENCE

  1. Delahanty LM, Levy DE, Chang Y, et al. Effectiveness of lifestyle intervention for type 2 diabetes in primary care: The REAL HEALTH-diabetes randomized clinical trial. J Gen Intern Med 2020. doi: 10.1007/s11606-019-05629-9. [Epub ahead of print].